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Paed Device manuals > Medtronic Manuals > Flashcards

Medtronic Manuals Flashcards

1
Q

What are the Mycarelink app conditions for use

A

used anywhere that allows connection to internet or wifi
keep phone close to heart device (within 6 in or 15cm) to ensure the app can transmit for min 3hrs
updates are required for operating systems to support the app

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2
Q

What app updates are required whilst in use

A

the patient will not be able to use the app until the update is installed
If unable to then phone or tablet may no longer be supported

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3
Q

Upgrade to different remote monitoring

A

talk to doctor before deleting app
inform patient to delete app once new HM is set up

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4
Q

how do the app and my carelink communicate?

A

the device sends out a secure signal for the app several times an hr (mostly that there is nothing to report)

App -> device = bluetooth
App -> Carelink = internet

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5
Q

Requirements to keep app active for successful remote monitoring include?

A

Phone or tablet charged or On
Phone or tablet connected to Wifi or internet - to transfer data to Carelink
keep app open and running in background - to stay connected to device and regularly communicating
Keep phone or tablet close
Home tab shows Active
Enable bluetooth and notifications

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6
Q

IOS phone requirements for App operation

A

Background refresh App enabled otherwise data cannot be transferred
Limit use of low power mode - needs to be off for data transmission
Bluetooth On

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7
Q

Android phone requirements for App operation

A

Turn On location settings
Battery optimisation settings OFF
Battery saver mode - to transfer data

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8
Q

What is the length of time used for the App to communicate with the device?

A

5-15mins

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9
Q

What is the length of time used for the App to communucate with Carelink?

A

3 to 24hrs

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10
Q

How many devices can use the app at once?

A

Multiple device can be connected as long as device patient logs in with same email as his or her primary phone.

Set up primary phone then secondary phone

Symptom journal and vitals tracking are not set up across multiple devices so will have to be recorded separtely on each device if required.

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11
Q

Device alerts - post shock

A
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12
Q

Device alerts - HM disconnected

A
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13
Q

Device alerts - lead integrity

A

If lead impedance falls outside of range at either end of the spectrum (20-200) the device will alarm every 4hrs starting from programmed time.

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14
Q

VF detection criterion in ICD’s

A

75% of total beats detected should fall with the detection zone.

If more than 25% of the total number of intervals to detect (NID) is not sensed then reprogramming is required.

I.e. total beats = 16. 25% of 16 = 4 so > 4 beats need to be undersensed before programming is required.

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15
Q

Where would you be able to confirm how the device detected the episode?

A

Using stored EGM and episode text

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16
Q

RV lead noise discrimination and environmental noise

A

RV lead pose algorithm does not prevent inappropriate shock from external noise

Compares far-field and near field

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17
Q

Highest atrial capture management values

A

values cannot be auto adjusted above 5.0V or 1.0ms

*if outputs above 5.0V or 1.0ms are required then it has to be manually programmed in

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18
Q

AT/AF feature in CRT-P devices post implantation

A

AT/AF detection or Atuo atrial ATP therapies should not be programmed on until 1 month post implant for risk of dislodgement into RV

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19
Q

What causes device reset?

A
  • exposure to temps <18 degrees celcius
  • strong electromagnetic fields
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20
Q

Identify partial reset

A

pacing in programmed mode with many programmed settings retained

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21
Q

Identify full reset

A

device operates in VVI 65ppm

*reprogramming required to restore device

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22
Q

False bipolar pathway with unipolar lead

A

when implanting unipolar lead, ensure tip setscrew is engages and all electrical contacts are sealed to prevent electrical leakage.

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23
Q

Side effects of electrical leakage

A

device can inappropriately identify a unipolar lead as bipolar = loss of output

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24
Q

Side effects of electrical leakage

A

device can inappropriately identify a unipolar lead as bipolar = loss of output

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25
Q

AV delay optimisation in CRT-P devices requirements

A

Requires adaptive AVs to be programmed OFF

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26
Q

Pace polarity and MRI

A

Pace polarity must be programmed Bipolar for MRI surescan mode to be programmed ON

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27
Q

What conditions have to be met to reprogramme AV delays on CRT devices?

A

Adaptive AV needs to be programmed OFF

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28
Q

Carelink home monitoring

A

Unscheduled
- alerts = auto send due to device alert
- event summary = patient sent it

Scheduled
- auto send

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29
Q

Requirements for AT/AF detection or therapy in CRT devices

A

Not to be programmed ON until 1 month post implantation due to risk of Atrial lead displacement into RV = VT/VF

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30
Q

Percepta CRT-P is contraindicated for

A

Concomitant implant with another Brady device or ICD

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31
Q

Contraindications for rate responsive modes

A

Those who cannot tolerate pacing rate above programmed lower rate

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32
Q

Contraindication for dual chamber sequential pacing

A

Patients with chronic or persistent SVTs I.e. AF/AFluttter

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33
Q

Asynchronous is contraindicated in

A

The presence of competition between paced and intrinsic rhythms

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34
Q

Single chamber pacing is contraindicated in…?

A

Patients with AV conduction disturbance

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35
Q

ATP therapy is contraindicated in…?

A

The presence of accessory antegrade pathway

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36
Q

When can MRI surescan mode not be programmed ON?

A

When indicated for replacement

If device is programmed to unipolar

*device must be in bipolar pace configuration to be programmed MRI mode
*MRI is not recommended if RV lead threshold is >2.0V @ 0.4ms

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37
Q

MRI contraindications

A

Implanted lead connectors, lead adapters or abandoned leads

Broken leads or intermittent electrical contact

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38
Q

Explain Adaptive CRT

A

CRT parameters are adaptive automatically whilst patient is ambulatory

Normal PR interval = LV pacing only
Prolonged PR interval = BiVp

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39
Q

RV/Atrial capture management max settings

A

RV/Atrial thresholds are not auto adjusted above 5.0V or 1.0ms

*if higher is required then it has to be manually programmed

40
Q

Device reset:

Partial vs full reset

A

Caused by low temps or EMI fields

Partial reset - pacing resumes in programmed mode and settings retained

Full reset - Programmed to VVI 65bpm and warning message m. Device must be reprogrammed

41
Q

Conditions for phrenic nerve stimulation

A

High LV pacing amplitudes

*determine min pacing threshold for phrenic nerve stimulation and programme output to value with least effect but still 2x safety margin.
*use alternate LV pacing vectors

42
Q

Conditions for PMT intervention

A

Prevents PMT only when VA conduction time is less than 400ms

*slow retrograde conduction May induce PMT when VA condition time is longer than 400ms

43
Q

Adapts/Versa/sensia/Relia

Automatic rate response adjusts how many times a day and is enabled how many minutes after implant?

A

After implant RR is auto adjusted once a day of necessary.

30mins post implant - pacing occurs at the implanted mode without RR

30 mins after implant, RR is enabled

44
Q

Adapta/versa/sensia/Relia

What is rate profile optimisation operation?

A

Auto adaption if ADL and exertion rate response levels once a day

Compares current sensor rate to target rate profile and optimises

*can operate in background of non-rate responsive mode

45
Q

What does the status bar show?

A

Current pacing mode
When any one of a number of test conditions is occurring
The pacemaker model

46
Q

Adapta/Relia/versa/sensia

Where to adjust programmer time and date?

A

Programmer > preferences

47
Q

Attesta/Sphera

Emergency pacing programmes device to what mode and rate?

A

VVI 70ppm
high output pacing to restore ventricular output in an emergency situation

*to terminate emergency VVI pacing, reprogramme device from parameters screen

48
Q

Attesta/Sphera

How does MRI surescan operate during emergency pacing?

A

disabled

49
Q

Attesta/Sphera

What modes is search AV + available in?

A

DDDR, DDD, DDIR, DDI, DVIR, DVI, or VDD

50
Q

Attesta/Sphera

True or false
If the pacemaker does not observe intrinsic ventricular activation during its periodic searches over the course of a week, it turns off the Search AV+ feature

A

True

51
Q

Attesta/Sphera

How is the PVARP value determined during Auto PVARP?

A

base don mean atrial rate (an average of all A-A intervals except those starting with an atrial sense or atrial refractory sense and ending with an atrial pace)

52
Q

What is the purpose of auto PVARP?

A

intended to provide a higher 2:1 block rate by shortening the PVARP and SAV (if necessary) at higher tracking rates and protect against PMTs at lower rates by providing a longer PVARP

53
Q

Implant detection overview

A

A 30 min period beginning at lead connection

Lead connection checked my measuring impedance

54
Q

Time interval for implant detection completion?

A

30 mins

55
Q

What is activated following completion of implant detection?

A

Operating polarity (auto configuration can occur)
MVP operations
Adaptive sensitivity settings
Rate responsive pacing
Adaptive ventricular output settings
Diagnostic data collection

56
Q

How does adaptive lead monitoring work

A

Monitors bipolar paces for high impedance and provides unipolar backup paces when high impedance is detected

Switches sensing and pacing polarity from bipolar to unipolar then changes to monitor only when polarity switches

57
Q

How does lead monitoring work when programmed monitor only?

A

Monitors either unipolar or bipolar paces to determine if they are out of range but does not switch polarity when out of range is detected.

58
Q

What is the monitor sensitivity for lead monitor feature on devices?

A

Number of high or low impedance paces out of 16 that define an out of range lead on each channel

59
Q

True or false

Lead monitor should be programmed to adaptive in ICDs

A

False

Auto programming to unipolar sensing configuration increases risk of muscle noise oversensing = inappropriate therapy

60
Q

Auto lead impedance measurements is based on measurements taken every how many hrs?

A

Every 3hrs for each chamber being paced

  • min, avg and max are recorders every 7 days for the most recent 14 months
61
Q

How many lower voltages readings are required for a device to declare RRT?

A

3

62
Q

T wave discrimination operation feature

A

analyses differences in amplitude, frequency content and pattern to distinguish R and T patterns.

63
Q

When is T wave discrimination applied?

A

Applied in initial detection and redetection

64
Q

Explain assumptions involved in T wave discrimination

A

Operates on the assumption that R and T waves have different waveform characteristics:

  • R waves have higher frequency
    So uses frequency filter to make R wave bigger enabling R-T pattern recognition
65
Q

When MRI sites can mode is programmed ON, what happens to detection and therapies?

A

Tachyarrhythmia detection and therapies are suspended.

66
Q

Explain high-rate time out

A
67
Q

Explain onset

A
68
Q

Explain AT/AF detection

A
69
Q

Explain reactive ATP algorithm

A
70
Q

Explain confirmation+

A
71
Q

Explain PR logic

A
72
Q

Explain Wavelet

A
73
Q

Explain RV lead integrity alert

A
74
Q

explain RV lead noise discrimination and alert

A
75
Q

Define the different between consecutive and probablistic counters?

A

Consecutive = following one another
Probablistic = certain quantity in a period of time

76
Q

SVT wavelet Vs SVT-ST

A
77
Q

True or false

An interval classified in the VT zone increments the VT counter by +1; an interval classified in the VF area does not alter the VT counter (no increment, no decrement)

A

True

78
Q

True or false

a long interval classified as VS resets the VT counter to 0.

A

True

79
Q

True or False

The VT counter is reset with VF intervals but not VS intervals

A

False

VT counter is reset with VS intervals but tolerates VF intervals which do not reset the counter.

The zones operate independently of each other

80
Q

Why is the VT counter not suitable for VTs greater than 200bpm?

A

Signals tend to be of varying amplitudes = risk of undersensing = big enough pause (rate out of VT zone) causes VS resetting counter = delay to therapy.

81
Q

What is the primary benefit of the VT zone?

A

For tachycardias < 200bpm:

  1. To effectively detect MVT
  2. First level discrimination for AF (irregular rhythm with long intervals out of VT zone causing VS)
82
Q

VT zone programmed at 160bpm sees a polymorphic tachycardia that ranges between 240bpm to 150bpm. What is the problem with this scenario?

A

Tachy can fall in and out of zone (VS markers that reset VT counter each time) leading to delay to therapy.

83
Q

What is the optimal rate to programme for a VT zone?

A

10-20bpm slower than clinical VT

84
Q

Why is a VT zone for tachy with rates >200bpm not advised?

A

Risk of falling out of VT zone due to undersensing or drop out causing counter reset (inappropriate VS intervals) -> delay to tachy detection & therapy.

85
Q

True or false

VF counter is a consecutive counter

A

False

VF counter is probabilistic

86
Q

What is the criteria for detection in the probabilistic VF zone?

A

75% fast intervals

programming possibilities: 9/12, 12/16, 18/24, 24/32, 30/40, etc)

87
Q

What characteristics of VF increase risk of undersensing and this make the probabilistic counter preferable?

A

fast, disorganized, chaotic, with ventricular signals of low and/or variable amplitude

88
Q

End of episode counter is based on what?

A
  1. 8 consecutive VS or VP intervals slower than the lowest programmed detection zone (VF or VT)
  2. For 20 seconds, the median of 12 consecutive intervals is always slower than the programmed lowest detection zone (VF or VT).
89
Q

Why is re detection intervals programmed shorter than initial detection?

A

risk of undersensing increasing with the duration of the arrhythmia

end of episode criteria

90
Q

Recommended programming for primary prevention

A

Single VF zone at 187-200bpm

91
Q

Recommended programming for secondary prevention

A

VF zone from 187 to 200 beats/minute and VT zone 20 beats per minute slower than clinical tachycardia.

92
Q

If programming a VT via VF/VT zone was indicated, what should be programmed for tachy >200bpm and why?

A

FVT via VF

Because the VT counter was designed for monomorphic tachycardias and not for tachycardias> 200 beats/minut

93
Q

What is the recommended programming for tachy between 200-230bpm when FVT via VF/VT is programmed?

A

1-2 ATP sequences before shocks

94
Q

What is the disadvantage is that the VF and VT zone being independent of each other (I.e. a VF counter does not affect VT counter and vice versa)

A

when an arrhythmia fluctuates between the VT zone and the VF zone can theoretically lead to a delay in diagnosis

95
Q

What is the purpose of the combined counter?

A

designed to resolve delay to detection with a tachy that straddles the VT/VF zone.

always active (non-deprogrammable) if a VT zone and VF zone have been programmed.

96
Q

Feature operation:

Combined count

A

triggered after the detection of 6 FS intervals and fulfilled based on initial detection intervals of VF zone. Checks last 8 intervals and if one is FS = VF therapy. If one is TS = VT therapy

E.g. 30/40, the combined counter was therefore filled after 35 intervals classified as TS or FS (7/6 of 30 = 35).

97
Q
A

Paed Device manuals (7 decks)

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